MEDICARE: HUNTER W JACQUES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA6647	MA
2	363A00000X	Physician Assistant	4855	SC

General Provider Information

NPI Number	:	1326529041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER W JACQUES PA-C

Provider Business Mailing Address
First Line	:	30 COURTENAY DR
Second Line	:	MSC 702, SUITE 287; ATTN: MICHELLE POTTER
City	:	CHARLESTON
State	:	SC
Zip	:	29425-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 2ND AVE STE 101
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-7887
Country	:	US
Telephone Number	:	843-722-8000
Fax Number	:	843-266-5125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	12/10/2025

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